The bald facts are these. Since his first report in 2002, total NHS spending has surged by nearly 50%, or £43.2bn. That's a real terms growth of 7.4% pa, and takes us close to the EU average for health spending as a percentage of GDP. So as of now, nobody can argue the NHS is substantially underfunded.

But as we've said many times on BOM, spending money is easy: it's what you get back that's counts. And across 321 weighty pages Wanless confirms that we've had abysmal value.

To start with, getting on for half of the increased spending (£18.9bn) was gobbled up in those big pay and price increases (see many previous blogs on the NHS pay deals). More money has been poured into hopeless projects like the NPfIT, where the report demands a full drains up.

Second, although there has been a huge increase in NHS staff numbers - up by one-third to 1.3m - their productivity has fallen sharply. Here for example is what's happened to hospital admissions per consultant:

Third, the top politicos and their ranks of health commissars did an appalling job at directing the splurge. Wanless produces the following scorecard, and it's well worth clicking on it to enlarge so you can take in the full enormity of what he's saying. Under virtually every single heading of the Cabinet Office's own criteria for good policy making, there has been total failure:

And even where their general policy direction might have been sound, their execution was dire. For example, they had a plan to recruit more clinical staff- good. But they somehow (duh) ended up recruiting far more than they planned, as this table shows:

Obviously there was insufficient home-grown supply because training takes time. So many recruits came from overseas, with all the attendant language difficulties you can now see in any NHS ward. And guess what- when our own expensively trained docs and nurses finally did become available, there were no jobs left. Indeed, some of the earlier over-recruitment was having to be trimmed, at huge redundancy cost.

What a shambles.

If we needed any further proof of the commissars' unsuitability to run our healthcare- or indeed anything else of consequence- this is surely it.

With our "health outcomes"- including cancer survival rates and infant mortality- still woefully below EU averages, how dare they pretend they're just about to address "the last few issues". As this report so graphically highlights, even when money is unlimited, they have neither the insight, interest, nor ability to do better.

A major opportunity has been bungled, and now the cash screw is tightening, all we can look forward to is further pontification, further destructive orders from the command bunker, and futher non-delivery.

PS This report is a goldmine of facts and figures, and I will be blogging other extractions in due course.

BOM the book now available

Drawing on six years of blogging government waste, this book shows how we spend far more than we need on our public services. It sets out the facts and explores the underlying issues. Just why does government spend so much and deliver such second rate service? Why do we put up with it? And what are the alternatives?

ABOUT BOM

Despite all the talk of cuts, government still consumes nearly half our national income. Yet many tens of billions of its spending is wasted, with taxpayers made to pick up the tab for a depressing array of overpriced sub-standard services. This is money we can no longer afford, and our National Debt is already at danger level.

If we're to avoid further decades of stagnation and austerity we urgently need to find another way. Exposing and understanding the wastefulness of government is a necessary step in the right direction.